Thursday, April 12, 2007

How do you teach a child to begin with the end in mind?

How do you teach a child to begin with the end in mind? Keeping in mind that adults teach what they do, not what they say, and that learning needs feedback and doesn’t happen without it.

For children, beginning with the end in mind means beginning with an unmet desire; needs and drives are the responsibilities of their carers. And those desires are likelier to be impulsive than planned. Frustration is likelier to promote learning than easy and early success. All this suggests that teaching an awareness of ends will be very challenging.

Sometimes it is better to act before you think; most times it is better to think before you act.

So, these are the necessary conditions: an unmet desire that has been frustrated; a proximate non-malevolent desire that can be satisfied given some help and thought and the willingness and patience to teach something that can be taught.

An awareness of ends implies an awareness of ecology: how things fit together, how they relate, what the facilitators and obstructors are or are likely to be.

Friction and inertia are practically ubiquitous. They are easily taught and often forgotten. The motivations of others are difficult to ascertain and confirm and are always changeable. And it is natural and common to ascribe to others degrees of latitude that are greater than we are aware of having ourselves.

Knowing how to teach children would make teaching adults easy.

Saturday, April 07, 2007

Problem Based Learning

A letter to my consultants:

I am committed to being better. This is not an occasional goal or aspiration: it is me. Kaizen. I am not in competition with my future self but I am driven by an ideal self that may not be realised.

I have a great deal to learn and my learning progresses day by day. Learning is what I do.

I understand that protocols exist to standardise safe practice. Both standardisation and safety are important severally and together for many reasons. Standardisation should not mean petrification.

Auditing my own practice more intensively over the past 6-9 months, one of my goals has been to reduce my admission rates and to do so safely. So, I have paid more attention to the numbers and been more aggressive with treatments: keeping in mind that more aggressive action needs finer feedback, more acute monitoring – time is a resource that acts.

I have said many times that I am not invested in specific acts; I am invested in process.

We agree that practice should be informed by evidence and that evidence is sparse; however, we do generate evidence and don’t use it to inform our practices. When evidence exists to change practice and you don’t, it would be helpful if you could say what (achievable) evidence would be necessary to change practice. As consultants, ultimately responsible for safe practice in the unit, it would be considerate if in changing the management of my patients you did so because you believed it necessary rather than preferable. Art is always arguable: your interventions should benefit me as well as the patient. If you don’t change my mind about my course you won’t change my practice – and so you do me and my future patients a disservice if a change in practice is necessary.

Medicine is experiential; no book learning can substitute for treating patients. And guided, moderated experience always beats trial-and-error learning.